2021-11-24T20:29:32-06:00 2020-12-31 135565207 KPMG LLP 90 S 7TH ST STE 4200 MINNEAPOLIS MN 55402 990 2020-10-01 390837206 LAKEVIEW MEDICAL CENTER INC OF RICE LAKE LAKE 7152341515 1700 W STOUT STREET RICE LAKE WI 54868 GORDON T EDWARDS COO/CFO 7152341515 2021-11-23 1 GORDON EDWARDS 999009999 MONROE J GIERL P01413237 6123055000 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z SUSAN TURNEY MD CEO 1000 N OAK AVENUE MARSHFIELD WI 54449 43586994 0 X WWW.LAKEVIEWMEDICAL.COM X 1919 WI SEE SCHEDULE O.WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 8 5 0 250 0 0 1122342 830235 148204540 42744024 16635 11734 5176 1001 149348693 43586994 1317843 610318 0 0 60235769 17149038 0 0 0 67353062 18885320 128906674 36644676 20442019 6942318 142587331 137256294 59944906 56057719 82642425 81198575 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 0 0 29205014 610318 42745025 LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE IS A NOT-FOR-PROFIT 40-BED COMMUNITY HOSPITAL LOCATED IN RICE LAKE, WISCONSIN THAT PROVIDES MEDICAL, SURGICAL, EMERGENCY, OUTPATIENT, DIALYSIS, AMBULANCE, ONCOLOGY, HOSPICE AND HOME HEALTH SERVICES. 29205014 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X CATHY BUKOWSKI VP OF FINANCE 7153875511 1000 N OAK AVENUE MARSHFIELD WI 54449 MARK BUGHER CHAIR 1.00 9.00 X X 0 32500 0 MARK BRADLEY VICE CHAIR 1.00 5.00 X X 0 8500 0 CHUCK NASON SECRETARY 1.00 4.00 X X 0 4750 0 JOHN BALTUS TREASURER 1.00 0.00 X X 0 0 0 SUSAN SUTTER BOARD MEMBER 1.00 0.00 X 0 0 0 SUSAN TURNEY MD BOARD MEMBER/MCHS CE 1.00 54.00 X 0 2834416 291778 RUWAN DISSANAYAKE MD BOARD MEMBER 1.00 50.00 X 0 492987 47500 NARAYANA MURALI MD BOARD MEMBER/MCHS CS 1.00 54.00 X 0 1082372 50238 WILLIAM MELMS MD CHIEF MEDICAL OFFICER 1.00 54.00 X 0 607112 45360 JERARD JENSEN MCHS GENERAL COUNSEL 1.00 54.00 X 0 986292 46087 GORDON EDWARDS MCHS CFO/COO 1.00 54.00 X 0 1003980 50671 NED WOLF FORMER LMC CEO 0.00 0.00 X 0 307946 1539 CINDY ARTS-STRENKE FORMER LMC COO 0.00 50.00 X 0 252607 38276 STEVEN KULICK FORMER CHIEF EXP. OFF. 0.00 0.00 X 0 471868 12843 0 8085330 584292 0 1 1 0 0 830235 830235 NET PATIENT SVC REV 621110 42603233 42603233 CAFETERIA REV 621110 78711 78711 MISC OTHER OP REV 621110 48428 48428 INTERCOMPANY REV 621110 11260 11260 WELLNESS REV 621110 2392 2392 42744024 11734 11734 VENDING REVENUE 900099 1001 1001 1001 43586994 42745025 0 11734 610318 610318 14132399 13810343 322056 646464 633697 12767 1677534 1653338 24196 692641 685013 7628 1858952 1697325 161627 107033 100800 6233 103171 103171 157293 155354 1939 98244 98220 24 341257 341257 1002939 1002939 MEDICAL SUPPLIES 7038571 7038203 368 I/C PURCHASED SERVICES 6901947 0 6901947 BAD DEBT EXPENSE 616947 616947 WI MEDICAID ACCESS TAX 414947 414947 244019 243142 877 36644676 29205014 7439662 0 X 26730302 30382647 143095 438316 0 0 51232061 43286392 0 0 0 0 0 0 2341478 1763332 37836 0 110538696 49618031 61692807 60920665 0 0 0 0 0 0 57500 0 352252 464942 142587331 137256294 114107 1892259 4853 4853 18440940 12534688 0 0 0 0 0 0 41039111 41166996 0 0 345895 458923 59944906 56057719 X 82642425 81198575 0 0 82642425 81198575 142587331 137256294 X 6942318 -8386168 X 0 1 X 1 1 1 X 0 4503454 4503454 70941370 24642709 46298661 427997 278045 149952 31217033 22771725 8445308 3448842 1925552 1523290 60920665 DEFERRED COMPENSATION 458923 458923 X PART X, LINE 2: THE ORGANIZATION APPLIES FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES (ASC 740), WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. UNDER ASC 740, TAX POSITIONS WILL BE EVALUATED FOR RECOGNITION, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND WILL PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. THE SYSTEM HAS DETERMINED THAT IT DOESN'T HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2020 OR SEPTEMBER 30, 2019. 1 1 X 1 X 1 X 1 1 1 0 1 1 249376 0 249376 0.00680 5526601 3143336 2383265 0.06500 0 0 0.00000 5775977 3143336 2632641 0.07180 42918 2392 40526 0.00110 9321 0 9321 0.00030 0 0 0.00000 0 0 0.00000 0 0 0.00000 52239 2392 49847 0.00140 5828216 3145728 2682488 0.07320 1 252085 0 8420613 11604029 -3183416 X 1 1 1 1 MARSHFIELD MEDICAL CENTER - RICE LAKE 1700 W STOUT STREET RICE LAKE WI 54868 82 X X X MARSHFIELD MEDICAL CENTER - RICE LAKE 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X WWW.LAKEVIEWMEDICAL.COM X 1 18 1 WWW.LAKEVIEWMEDICAL.COM 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 PART V, LINE 5: MARSHFIELD MEDICAL CENTER-RICE LAKE (MMC-RL) COMPLETED THE 2018 CHNA IN PARTNERSHIP WITH BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS), WISCONSIN DIVISION OF PUBLIC HEALTH, UNIVERSITY OF WISCONSIN-EAU CLAIRE, WISCONSIN INDIANHEAD TECHNICAL COLLEGE (WITC), ADRC OF BARRON, RUSK, AND WASHBURN COUNTIES, AND THE OTHER HEALTHCARE SYSTEMS IN THE COMMUNITY. IN ADDITION TO ANALYZING DEMOGRAPHIC INFORMATION, THE GROUP COLLECTED SECONDARY DATA THROUGH BOTH AN ONLINE AND PAPER SURVEY CONCERNING DISEASE, DEATH, DISABILITY, INJURY AND COMMUNITY OPINIONS. THE SURVEY WAS TRANSLATED TO SOMALI AND SPANISH TO INCLUDE FEEDBACK FROM UNDERSERVED POPULATIONS IN THE COUNTY. PART V, LINE 6A: THE CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITY(S):- MAYO CLINIC HEALTH SYSTEMS- CUMBERLAND HEALTHCARE - AMERY HOSPITAL AND CLINIC PART V, LINE 6B: THE CHNA WAS CONDUCTED WITH THE FOLLOWING NON-HOSPITAL FACILITY(S):- BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS)- WISCONSIN DIVISION OF PUBLIC HEALTH-WESTERN REGION OFFICE - UNIVERSITY OF WISCONSIN-EAU CLAIRE - WESTERN INDIANHEAD TECHNICAL COLLEGE (WITC) - AGING AND DISABILITY RESOURCE CENTER OF BARRON, RUSK, AND WASHBURN COUNTIES- RICE LAKE AREA FREE CLINIC - NORTHLAKES COMMUNITY CLINIC PART V, LINE 11: MARSHFIELD MEDICAL CENTER-RICE LAKE WILL IMPLEMENT MANY STRATEGIES TO COLLABORATE WITH COMMUNITY AND MARSHFIELD CLINIC HEALTH SYSTEM PARTNERS. COMMUNITY CHANGE IS A LONG-TERM PROCESS THAT NO ONE ORGANIZATION CAN ACCOMPLISH ALONE, THEREFOR PARTNERSHIPS ARE ESSENTIAL FOR SUCCESS. THE FOLLOWING WERE IDENTIFIED BY THE COMMUNITY HEALTH ASSESSMENT:- SUBSTANCE ABUSE - MENTAL HEALTH - CHRONIC DISEASE DUE TO THE INTERCONNECTED NATURE OF THE TOP IDENTIFIED HEALTH PRIORITIES, MMC-RL CHOSE TO COMBINE A NUMBER OF HEALTH PRIORITIES AND ARE AS FOLLOWS ALONG WITH THE GOALS AND STRATEGIES IDENTIFIED TO ACHIEVE THEM. ALCOHOL AND SUBSTANCE ABUSECOMMUNITY-BASED GOALS ARE TO REDUCE UNDERAGE AND EXCESSIVE ALCOHOL CONSUMPTION AND OPIOID RELATED DEATHS AND HARM. STRATEGY 1: SUPPORT IMPLEMENTATION OF AN ALCOHOL AND OTHER DRUG ABUSE (AODA) PREVENTION CURRICULUM- MMC-RL WILL PARTNER WITH LOCAL ORGANIZATIONS TO SUPPORT THE IMPLEMENTATION OF AN AODA PREVENTION CURRICULUM TO REDUCE UNDERAGE ALCOHOL CONSUMPTION AND/OR PREVENT SUBSTANCE USE AND ABUSE. STRATEGY 2: SUPPORT LOCAL POLICY RELATED TO UNDERAGE DRINKING PREVENTION- MMC-RL WILL PARTNER WITH LOCAL ORGANIZATION(S) TO SUPPORT THE IMPLEMENTATION OF A NEW OR IMPROVED POLICY RELATED TO UNDERAGE DRINKING PREVENTION. STRATEGY 3: ENGAGE IN AODA PREVENTION COMMUNITY GROUPS- MMC-RL STAFF WILL ACTIVELY ENGAGE IN THE BARRON COUNTY COMMUNITY COALITION (BC3) THAT ADDRESSES AODA. BEHAVIOR HEALTH COMMUNITY-BASED GOALS ARE TO DECREASE SUICIDE RATES AND IMPROVE SOCIAL AND EMOTIONAL DEVELOPMENT OF CHILDREN AND ADOLESCENTS. STRATEGY 1: SUPPORT COMMUNITY TRAINING RELATED TO MENTAL HEALTH AND SUICIDE PREVENTION- MMC-RL WILL SUPPORT LOCAL COMMUNITY ORGANIZATION(S) IN PROVIDING QPR TRAININGS TO 500 BARRON COUNTY RESIDENTS. STRATEGY 2: SUPPORT COMMUNITY EDUCATIONAL EVENT(S) RELATED TO MENTAL HEALTH AND/OR SUICIDE PREVENTION- MMC-RL WILL PARTNER WITH AT LEAST ONE COMMUNITY ORGANIZATION TO HOST EDUCATIONAL EVENT(S) WHERE THE DOCUMENTARY, THE RIPPLE EFFECT, WILL BE VIEWED. STRATEGY 3: DEVELOP AODA AND MENTAL HEALTH RESOURCE APP.- MMC-RL WILL ASSIST IN THE DEVELOPMENT OF AN APP FOCUSED ON PROVIDING COMMUNITY MEMBERS, SPECIFICALLY YOUTH ACCESS TO INFORMATION ABOUT EXISTING AODA AND MENTAL HEALTH SERVICES AND RESOURCES. STRATEGY 4: ENGAGE IN MENTAL HEALTH COMMUNITY GROUPS- MMC-RL STAFF WILL ACTIVELY ENGAGE IN COMMUNITY CONNECTIONS TO PROSPERITY (CCP): MENTAL HEALTH ACTION TEAM THAT ADDRESSES MENTAL HEALTH.CHRONIC DISEASE COMMUNITY-BASED GOALS ARE TO IMPROVE ACCESS TO HEALTHY FOODS AND PHYSICAL ACTIVITY, IMPROVE SELF-MANAGEMENT OF CHRONIC CONDITIONS AND REDUCE TOBACCO USE. STRATEGY 1: PROVIDE A YEARLY PRIMARY PREVENTION STRATEGY THAT SUPPORTS CARE DELIVERY EFFORTS RELATED TO CHRONIC DISEASE MANAGEMENT - MMC-RL WILL PARTICIPATE ALONG WITH CUMBERLAND HEALTHCARE AND MAYO CLINIC HEALTH SYSTEM IN HOLDING KNOW YOUR NUMBERS EVENTS OPEN TO THE COMMUNITY THAT SCREEN RESIDENTS FOR CHRONIC DISEASE RISK FACTORS. STRATEGY 2: PROVIDE SELF-MANAGEMENT EDUCATION OF PRE-DIABETES THROUGH THE NATIONAL DIABETES PREVENTION PROGRAM- MMC-RL WILL IMPROVE REFERRALS/ACCESS TO MMC-RL NATIONAL DIABETES PREVENTION PROGRAM (DPP) STRATEGY 3: IMPROVE ACCESS TO HEALTHY CHOICES- MMC-RL WILL IMPLEMENT AN EDUCATIONAL CAMPAIGN REGARDING SUGAR SWEETENED BEVERAGES STRATEGY 4: ENGAGE IN CHRONIC DISEASE PREVENTION COMMUNITY GROUPS- MMC-RL STAFF WILL ACTIVELY ENGAGE IN THRIVE: BARRON COUNTY CHRONIC DISEASE PREVENTION COALITION THAT ADDRESSES CHRONIC DISEASETHE FOLLOWING HEALTH PRIORITIES WILL NOT BE ADDRESSED BY MMC-RL FOR REASONS INDICATED: - INJURY & VIOLENCE PREVENTION: INJURY AND VIOLENCE ARE IMPORT AREAS OF FOCUS. INSTEAD OF LEADING THIS CHARGE, MMC-RL STAFF PARTICIPATE IN A VARIETY OF COMMUNITY GROUPS SUPPORTING THIS AREA INCLUDING, BARRON-WASHBURN COUNTY CAREGIVER COALITION AND COMMUNITY CONNECTIONS TO PROSPERITY (CCP). EMBRACE INC. (A DOMESTIC VIOLENCE AND SEXUAL ASSAULT AGENCY THAT PROVIDES SAFE SHELTER AND SUPPORTIVE SERVICES FOR SURVIVORS), AGING AND DISABILITY RESOURCE CENTER (ADRC) OF BARRON, RUSK, AND WASHBURN COUNTIES, AND BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) LEAD AND HAVE EXPERTISE IN THIS AREA. - COMMUNICABLE DISEASE PREVENTION & CONTROL: THIS IS AN IMPORTANT AREA OF FOCUS, MMC-RL HAS SYSTEMS AND PROCESSES IN PLACE TO PREVENT AND REDUCE THE SPREAD OF COMMUNICABLE DISEASES. THE HOSPITAL WILL NOT TAKE THE LEAD ON THIS AREA IN COMMUNITY OUTREACH AS THIS IS AN AREA THE BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) LEADS AND HAS EXPERTISE IN. - ORAL HEALTH: MARSHFIELD CLINIC RICE LAKE DENTAL CENTER ADDRESSES THE COMMUNITY NEED FOR ORAL HEALTH BY SERVING PATIENTS REGARDLESS OF ABILITY TO PAY OR INSURANCE STATUS. WHILE MMC-RL ADDRESSES ORAL HEALTH IT IS NOT LISTED AS ONE OF THE TOP HEALTH PRIORITIES. - REPRODUCTIVE & SEXUAL HEALTH: WHILE MMC-RL DOES PROVIDE THIS SERVICE, COMMUNITY LEAD INITIATIVES ARE BEST LEAD BY THE BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) AND OTHER AGENCIES WITH EXPERTISE IN THE AREA. - ENVIRONMENTAL & OCCUPATIONAL HEALTH: WHILE MMC-RL DOES HAVE A VIBRANT OCCUPATIONAL HEALTH DEPARTMENT, THE HOSPITAL WILL NOT TAKE THE LEAD ON THIS AREA IN COMMUNITY OUTREACH AS THIS IS AN AREA THE BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) LEADS AND HAS EXPERTISE IN. PART I, LINE 3C: AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON INCOME AS COMPARED WITH FEDERAL POVERTY GUIDELINES. OTHER ELIGIBILITY FACTORS INCLUDE: ASSET LIMITATIONS, INSURANCE STATUS AND RESIDENCY. ACCOUNT BALANCE IS CONSIDERED FOR MEDICAL INDIGENCE ELIGIBILITY. PART I, LINE 7: EXPLANATION OF COSTING METHODOLOGY USED FOR CALCULATING LINE 7 TABLE:AMOUNTS CALCULATED IN PART I, LINE 7 ARE DETERMINED BASED ON A COST-TO-CHARGE RATIO. OTHER BENEFITS ARE DETERMINED BASED ON THE DIRECT AND INDIRECT COSTS (WHERE ALLOCATED) ASSOCIATED WITH A PROGRAM NET OF EARNED REVENUE. PART II, COMMUNITY BUILDING ACTIVITIES: MARSHFIELD MEDICAL CENTER-RICE LAKE (MMC-RL) PARTICIPATED IN VARIOUS COMMUNITY BUILDING ACTIVITIES WITH THE PURPOSE TO IMPROVE THE HEALTH OF THE COMMUNITY, INCLUDING ADDRESSING SOCIAL DETERMINATES OF HEALTH AND HEALTH INEQUITIES. DUE TO COVID-19, MANY COMMUNITY BUILDING ACTIVITIES WERE LIMITED OR CANCELED DURING THIS REPORTING PERIOD. HOWEVER, STAFF DID PARTICIPATE IN REGIONAL COMMUNITY GROUPS COORDINATING EFFORTS TO ADDRESS COVID-19. SOME EXAMPLES OF COMMUNITY BUILDING ACTIVITIES INCLUDED: - COALITION BUILDING: MMC-RL STAFF PARTICIPATED IN MORE THAN TEN DIFFERENT COMMUNITY COALITIONS AND COLLABORATIONS WITH THE PURPOSE OF IMPROVING THE HEALTH OF THE COMMUNITY. A LIST OF COALITIONS AND COLLABORATIONS ARE LISTED IN MMC-RL CHNA AND IS DOCUMENTS ON THEIR MAIN HOSPITAL WEBSITE. - COMMUNITY SUPPORT: MMC-RL STAFF PARTICIPATED IN COMMUNITY PROGRAMS AND EVENTS. EXAMPLES INCLUDED: QUESTION, PERSUADE, AND REFER (QPR) TRAINING; VIRTUAL COMMUNITY SHOWING OF THE FILM SUICIDE: THE RIPPLE EFFECT - WORKFORCE DEVELOPMENT: MMC-RL COLLABORATED WITH AREA HIGH SCHOOLS TO OFFER PROGRAMS FOR HIGH SCHOOL STUDENTS INTERESTED IN MEDICAL CAREERS AS WELL AS OBSERVATIONAL JOB EXPERIENCES FOR HIGH SCHOOL GRADUATES. MMC-RL FUNCTIONED AS A CLINICAL SITE FOR STUDENT NURSES, STUDENT NURSING ASSISTANTS, PRECEPTORS FOR HEALTHCARE JOBS, AND MEDICAL RESIDENTS AND INTERNS. - ADVOCACY FOR COMMUNITY HEALTH IMPROVEMENTS AND SAFETY: MMC-RL COLLABORATED WITH COMMUNITY ORGANIZATIONS AND GROUPS FOR COMMUNITY HEALTH IMPROVEMENTS AND SAFETY. EXAMPLES INCLUDED: PARTICIPATION IN VARIOUS HEALTH DEPARTMENT DRIVEN GROUPS FOCUSED ON ADDRESSING THE IMPACTS OF COVID-19. PART III, LINE 2: BAD DEBT EXPENSE IS REPORTED AT COST USING A COST-TO-CHARGE RATIO. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED FOR EXPLICIT PRICE CONCESSIONS AND BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS AN IMPLICIT PRICE CONCESSION. IN EVALUATING THE COLLECTABILITY OF PATIENTS' ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND CONTRACTUAL TERMS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ADDITIONAL IMPLICIT DISCOUNT, IF NECESSARY (I.E., FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND CO-PAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS AN IMPLICIT DISCOUNT IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE. THE SYSTEM'S IMPLICIT ALLOWANCE FOR SELF-PAY PATIENTS WAS APPROXIMATELY 55% AND 41% OF SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2020 AND SEPTEMBER 30, 2019, RESPECTIVELY. PART III, LINE 8: THE ALLOWABLE MEDICARE COST ON PART III, LINE 6 IS DETERMINED USING THE CY 2020 MEDICARE COST REPORT. THE REIMBURSEMENT FROM MEDICARE IS DEDUCTED FROM THE ESTIMATED COST USING A COST-TO-CHARGE RATIO IN ORDER TO DETERMINE THE SHORTFALL FROM THE MEDICARE PROGRAM. THIS MEDICARE SHORTFALL LISTED ON LINE 7 IS NOT CURRENTLY TREATED AS COMMUNITY BENEFIT, HOWEVER, REPRESENTS SERVICES THAT ARE ESSENTIAL TO VARIOUS UNDERSERVED POPULATIONS IN THE COMMUNITY. PART III, LINE 9B: THE ORGANIZATION HAS A BILLING AND COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO BE ELIGIBLE OR PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. MULTIPLE MEASURES ARE TAKEN TO COMMUNICATE THE AVAILABILITY OF FINANCIAL ASSISTANCE AND DETERMINE WHETHER A PATIENT IS FINANCIAL ASSISTANCE ELIGIBLE BEFORE PURSUING EXTRAORDINARY COLLECTION ACTIONS (ECAS). ECAS MAY INCLUDE: REPORTING TO CONSUMER CREDIT REPORTING AGENCIES, PURSUING LEGAL JUDGMENTS, FILING LIENS, GARNISHING WAGES, REQUIRING PREPAYMENT FOR NON-EMERGENCY SERVICES. ECAS WILL NOT BE INITIATED AND FURTHER ACTION WILL NOT BE TAKEN ON EXISTING ECAS ONCE A FINANCIAL ASSISTANCE APPLICATION IS IN PROCESS. IF THE PATIENT IS DETERMINED FINANCIAL ASSISTANCE ELIGIBLE, REASONABLE MEASURES WILL BE TAKEN TO REVERSE ANY ECA ALREADY IN PLACE. PART VI, LINE 2: MARSHFIELD MEDICAL CENTER-RICE LAKE(MMC-RL) ASSESSED THE HEALTH CARE NEEDS OF THE COMMUNITIES BY CONDUCTING STANDARD CHNA PRACTICES, INCLUDING: - REVIEW OF COMMUNITY PARTNERS' REPORTS (I.E. UNITED WAY) - COMPLETION OF KEY INFORMANT INTERVIEWS WITH COMMUNITY LEADERS ABOUT THE COMMUNITY'S HEALTH NEEDS - REVIEW OF PUBLICLY AVAILABLE COMMUNITY HEALTH DATA (I.E. COUNTY HEALTH RANKINGS) - PARTICIPATION IN COMMUNITY HEALTH COMMITTEES AND BOARDS (I.E. THRIVE STEERING COMMITTEE) PART VI, LINE 3: PATIENT ASSISTANCE CENTER COUNSELORS ASSIST INDIVIDUALS WITH IDENTIFYING, REFERRING AND/OR APPLYING FOR PUBLIC, PRIVATE OR CHARITABLE RESOURCES FOR WHICH THE PATIENT MAY QUALIFY. COUNSELORS ARE AVAILABLE VIA PHONE AND IN PERSON TO ASSIST INDIVIDUALS WITH FINANCIAL ASSISTANCE.INFORMATION ON THE MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) FINANCIAL ASSISTANCE POLICY IS POSTED IN HOSPITAL REGISTRATION AND ADMITTING LOCATIONS AND IN THE HOSPITAL EMERGENCY DEPARTMENT. FINANCIAL ASSISTANCE INFORMATION IS PRINTED ON MONTHLY BILLING STATEMENTS AND INCORPORATED INTO OTHER COMMUNICATIONS IN ORDER TO WIDELY PUBLICIZE THE AVAILABILITY OF FINANCIAL ASSISTANCE, AS DESCRIBED IN THE MCHS BILLING AND COLLECTION POLICY. THE MCHS FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY ARE AVAILABLE IN ENGLISH, SPANISH, HMONG AND ANY OTHER LANGUAGE THAT IS THE PRIMARY LANGUAGE SPOKEN BY THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE POPULATION OF THE SERVICE AREA.THE MCHS FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY MAY BE OBTAINED FREE OF CHARGE: ON THE HOSPITAL WEBSITE, IN PERSON, FROM FINANCIAL COUNSELORS, BY PHONE AND BY MAIL. PART VI, LINE 4: MARSHFIELD MEDICAL CENTER-RICE LAKE (MMC-RL) SERVES BARRON COUNTY. BARRON COUNTY IS LOCATED IN THE NORTHERN REGION OF WISCONSIN. THE COUNTY IS COMPRISED OF FOUR CITIES (BARRON, CHETEK, CUMBERLAND, AND RICE LAKE), SIX VILLAGES (ALMENA, CAMERON, DALLAS, HAUGEN, NEW AUBURN, PRAIRIE FARM, AND TURTLE LAKE), AND 25 TOWNSHIPS WITH A TOTAL POPULATION OF 45,164 AND A POPULATION PERCENT CHANGE OF -1.5% IN 2018. WITH 65.9% OF BARRON COUNTY RESIDENTS LIVING IN A RURAL AREA. THE COUNTY IS BORDERED BY DUNN, CHIPPEWA, RUSK, WASHBURN, BURNETT, AND POLK COUNTIES. THE RACIAL MAKE-UP OF BARRON COUNTY IS 93.3% CAUCASIAN, 0.7% ASIAN, 2.6% HISPANIC OR LATINO, 1.3% TWO OR MORE RACES, 1.4% BLACK OR AFRICAN AMERICAN, AND 1.0% AMERICAN INDIAN AND ALASKA NATIVE. THE MEDIAN HOUSEHOLD INCOME IN BARRON COUNTY IS $49,257 COMPARED TO THE STATE AVERAGE OF $56,759. THE NUMBER OF ALICE (ASSET LIMITED, INCOME CONSTRAINED, EMPLOYED) HOUSEHOLDS IN BARRON COUNTY IS HIGHER THAN THE STATE AVERAGE AT 31% AND 25.8% COMPARATIVELY WITH THE POVERTY RATE OF 13% WHICH IS HIGHER THAN THE STATE AVERAGE OF 11%. THE UNEMPLOYMENT RATE IN BARRON COUNTY IS 3.5% WHICH IS SLIGHTLY HIGHER THAN THE STATE AVERAGE OF 3.3%. THE EDUCATION LEVEL OF BARRON COUNTY RESIDENTS IS LOWER THAN THE STATEWIDE AVERAGE. ACCORDING TO THE LATEST CENSUS ESTIMATES, 90.6% OF BARRON RESIDENTS HAVE A HIGH SCHOOL DIPLOMA, COMPARED TO 91.7% STATEWIDE. LIKEWISE, 19.5% OF BARRON RESIDENTS HAVE A BACHELOR'S DEGREE OR HIGHER, COMPARED TO 29% STATEWIDE. PART VI, LINE 5: MARSHFIELD MEDICAL CENTER-RICE LAKE (MMC-RL) FURTHERED ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY WITH THE FOLLOWING: REPRESENTATION ON THE COMMUNITY CONNECTIONS TO PROSPERITY (CCP) COALITION. THE MISSION OF THE COALITION IS TO HELP INDIVIDUALS, ORGANIZATIONS AND AGENCIES UNDERSTAND AND DEEPLY APPRECIATE THE IMMENSE POWER OF POVERTY. REPRESENTATION AND FACILITATION OF THE MENTAL HEALTH ACTION TEAM (MHAT) DEVELOPED FROM THE CCP COALITION. THE MISSION OF THIS ACTION TEAM IS TO EDUCATE AND REDUCE STIGMA OF MENTAL ILLNESS, WHICH WILL INCREASE AWARENESS AND REDUCE THE POTENTIALLY DEBILITATING CONSEQUENCES OF MENTAL ILLNESS (INCLUDING POVERTY, SUBSTANCE ABUSE, HOMELESSNESS AND MANY CHRONIC HEALTH CONDITIONS). PART VI, LINE 6: MARSHFIELD CLINIC WAS FOUNDED IN 1916 BY SIX PHYSICIANS PRACTICING IN MARSHFIELD, A RURAL CENTRAL WISCONSIN CITY. AT ITS INCEPTION, CLINIC FOUNDERS SAW RESEARCH AND EDUCATION AS CRITICAL TO THEIR PRACTICE OF HEALTH CARE AND THAT REMAINS SO TODAY. THE CLINIC BECAME A 501(C)(3) NONPROFIT ORGANIZATION IN 1992 AND IN 2014, MARSHFIELD CLINIC HEALTH SYSTEM, INC. WAS FORMED. THE HEALTH SYSTEM'S MISSION IS TO ENRICH LIVES AND CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. THE HEALTH SYSTEM TODAY IS AN INTEGRATED SYSTEM SERVING WISCONSIN AND BEYOND, WITH MORE THAN 12,000 EMPLOYEES INCLUDING OVER 1,400 PROVIDERS COMPRISING MORE THAN 170 SPECIALTIES AND SUBSPECIALTIES. ITS ENTITIES PROVIDE SERVICE AND HEALTH CARE TO MORE THAN TWO MILLION RESIDENTS THROUGH MORE THAN 60R 50 LOCATIONS IN 40 WISCONSIN COMMUNITIES IN NORTHERN, CENTRAL AND WESTERN WISCONSIN. PRIMARY OPERATIONS INCLUDE: MARSHFIELD CLINIC; MARSHFIELD MEDICAL CENTER HOSPITALS IN MARSHFIELD, EAU CLAIRE, BEAVER DAM, LADYSMITH, MINOCQUA, NEILLSVILLE, RICE LAKE, WESTON, PARK FALLS, AND MARSHFIELD CHILDREN'S HOSPITAL; MARSHFIELD CLINIC RESEARCH INSTITUTE, SECURITY HEALTH PLAN AND MARSHFIELD CLINIC HEALTH SYSTEM FOUNDATION. THE CLINIC OPERATES SEVERAL DENTAL CLINICS IN NORTHERN, CENTRAL AND WESTERN WISCONSIN, PROVIDING GENERAL FAMILY DENTISTRY AND DENTAL HYGIENE SERVICES TO MORE THAN 60,000 UNIQUE PATIENTS PER YEAR. THESE CENTERS WERE LAUNCHED THROUGH A COLLABORATION INCLUDING MARSHFIELD CLINIC, FAMILY HEALTH CENTER OF MARSHFIELD, INC., AND FEDERAL AND STATE AGENCIES, TO ADDRESS THE NEED FOR DENTAL CARE IN UNDERSERVED AREAS. THE CENTERS SERVE ALL PATIENTS REGARDLESS OF ABILITY TO PAY OR INSURANCE STATUS - UNINSURED/UNDERINSURED, PRIVATE PAY AND COMMERCIAL INSURANCE. THE HEALTH SYSTEM DEEPLY BELIEVES IN PROMOTING COMMUNITY HEALTH THROUGH BUILDING AND SUSTAINING STRONG INTERNAL AND EXTERNAL PARTNERSHIPS AND COLLABORATIONS. FOR THIS REASON, THE HEALTH SYSTEM AND ITS AFFILIATED ENTITIES WORK TOGETHER INTERNALLY AND EXTERNALLY WITH COMMUNITY PARTNERS, STAKEHOLDERS AND RESIDENTS TO IMPROVE COMMUNITY HEALTH. UNIQUE TO THE HEALTH SYSTEM IS ITS CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA), WHICH BUILDS BRIDGES BETWEEN THE HEALTH SYSTEM AND AREAS IN THE COMMUNITY WHERE PEOPLE LIVE, WORK AND PLAY. THE CCHA WORKS WITH COALITIONS, BUSINESSES, EDUCATIONAL SYSTEMS, LAW ENFORCEMENT AGENCIES, TRIBAL NATIONS, LOCAL GOVERNMENTS, AND OTHER HEALTHCARE PROVIDERS, NONPROFIT ORGANIZATIONS AND OTHER ENTITIES TO IMPROVE COMMUNITY HEALTH. THE CCHA INCLUDES HOSPITAL STAFF WHO ARE CLOSELY INVOLVED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IMPLEMENTATION STRATEGY (IS) IN THEIR RESPECTIVE COUNTIES. THIS HELPS TO ALIGN COMMUNITY HEALTH PRIORITIES IDENTIFIED IN THE CHNA WITH HEALTH SYSTEM PRIORITIES. 1 0 0 CHARITY CARE 40 610318 PART I, LINE 2: MARSHFIELD CLINIC HEALTH SYSTEM (INCLUDING LAKEVIEW MEDICAL CENTER INC.) PROVIDES EMERGENCY AND MEDICALLY NECESSARY HEALTH CARE SERVICES FOR FREE OR AT DISCOUNTED RATES TO PATIENTS WHO MEET CERTAIN ELIGIBILITY CRITERIA. PATIENTS SEEKING FINANCIAL ASSISTANCE APPLY BY COMPLETING A FINANCIAL ASSISTANCE APPLICATION. FREE CARE IS AVAILABLE FOR PATIENTS WITH INCOME AND EXCESS ASSET VALUES AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES. X X 1 1 X X X X X 1 1 0 1 1 1 1 0 0 SUSAN TURNEY MD BOARD MEMBER/MCHS CE 0 1736862 0 647870 0 449684 0 270161 0 21617 0 3126194 0 241400 NARAYANA MURALI MD BOARD MEMBER/MCHS CS 0 747104 0 272924 0 62344 0 21519 0 28719 0 1132610 0 0 GORDON EDWARDS MCHS CFO/COO 0 747640 0 210274 0 46066 0 21519 0 29152 0 1054651 0 0 JERARD JENSEN MCHS GENERAL COUNSEL 0 772789 0 171649 0 41854 0 21519 0 24568 0 1032379 0 0 WILLIAM MELMS MD CHIEF MEDICAL OFFICER 0 548327 0 43847 0 14938 0 21519 0 23841 0 652472 0 0 RUWAN DISSANAYAKE MD BOARD MEMBER 0 356702 0 103989 0 32296 0 21519 0 25981 0 540487 0 0 STEVEN KULICK FORMER CHIEF EXP. OFF. 0 153586 0 0 0 318282 0 5429 0 7414 0 484711 0 0 NED WOLF FORMER LMC CEO 0 23093 0 0 0 284853 0 866 0 673 0 309485 0 0 CINDY ARTS-STRENKE FORMER LMC COO 0 216873 0 22042 0 13692 0 18255 0 20021 0 290883 0 0 PART I, LINE 1A THE ORGANIZATION MAY OCCASIONALLY REIMBURSE OR PROVIDE A HOUSING ALLOWANCE FOR KEY EXECUTIVES IN ORDER TO ASSIST WITH RELOCATING TO THE AREA. THE ORGANIZATION MAY ALSO CONTRIBUTE TO OR REIMBURSE FOR HEALTH AND SOCIAL CLUB DUES AS DEEMED NECESSARY IN ORDER TO SUPPORT A BUSINESS NEED. PART I, LINE 3 THE MARSHFIELD CLINIC HEALTH SYSTEM'S (MCHS) INDEPENDENT COMPENSATION COMMITTEE (THE COMMITTEE) HAS FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS EMPLOYED BY ANY OF THE ORGANIZATIONS IN THE SYSTEM. THE COMMITTEE USES COMBINATIONS OF THE FOLLOWING TO EVALUATE COMPENSATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, AND WRITTEN EMPLOYMENT CONTRACTS. PART I, LINES 4A-B SEVERANCE NED WOLF - $277,000 STEVEN KULICK - $291,923 457(F) PLAN SUSAN TURNEY, MD - $278,676 RUWAN DISSANAYAKE, MD - $10,000 NARAYANA MURALI, MD - $10,000 WILLIAM MELMS, MD - $10,000 JERARD JENSEN - $10,000 GORDON EDWARDS - $10,000 NED WOLF - $2,500 CINDY ARTS-STRENKE - $10,000 PART I, LINE 5 SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS. PART I, LINE 6 SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS. FORM 990, PART IV, LINE 4: MARSHFIELD CLINIC HEALTH SYSTEM (INCLUDING LAKEVIEW MEDICAL CENTER INC.) IS A MEMBER OF VARIOUS HEALTHCARE ASSOCIATIONS (I.E. WISCONSIN HOSPITAL ASSOCIATION) THAT MAY PERFORM SOME LOBBYING ACTIVITY. ALL ASSOCIATED DUES ARE DISCLOSED ON THE FORM 990 OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. FORM 990, PART V, LINE 2: ALL PERSONNEL SERVICES FOR LAKEVIEW MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. ALL PHYSICIAN SERVICES FOR LAKEVIEW MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC, INC. FORM 990, PART VI, SECTION A, LINE 6 MCHS HOSPITALS, INC. (A WISCONSIN NONSTOCK, NONPROFIT ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3)) IS THE SOLE MEMBER OF LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE. FORM 990, PART VI, SECTION A, LINE 7A MCHS HOSPITALS, INC. (AS THE SOLE MEMBER) HAS THE RESERVE POWER TO APPOINT OR REMOVE MEMBER OF THE BOARD OF DIRECTORS OF LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE. FORM 990, PART VI, SECTION A, LINE 7B MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO APPROVE ANY CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS OF LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE. MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO INITIATE AND APPROVE LONG-TERM BORROWING AND OTHER FORMS OF LONG-TERM INDEBTEDNESS, INITIATE AND APPROVE THE PURCHASE, SALE OR ENCUMBRANCE OF REAL AND PERSONAL PROPERTY AND APPROVE OR DISAPPROVE ANNUAL OPERATING AND CAPITAL BUDGETS. MCHS HOSPITALS, INC. (THE SOLE MEMBER) ALSO HAS THE RIGHT TO INITIATE AND APPROVE ANY OF THE FOLLOWING ACTIONS: MERGER, CONSOLIDATION, AFFILIATION OR JOINT VENTURE WITH ANY OTHER ENTITY OR ENTITIES; LIQUIDATION, REORGANIZATION OR DISSOLUTION OF THE ORGANIZATION; FILING OF A VOLUNTARY PETITION IN BANKRUPTCY; ANY CHANGE IN CONTROL OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B MARSHFIELD CLINIC HEALTH SYSTEM, INC. ENGAGES A PUBLIC ACCOUNTING FIRM TO PREPARE AND REVIEW THE FORM 990 IN ADDITION TO REVIEW BY THE SYSTEM CFO/COO AND TAX DEPARTMENT. PRIOR TO FILING THE FORM WITH THE IRS, THE CFO AND HIS/HER DESIGNEE WILL PROVIDE TO EACH MEMBER OF THE SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE (A SUBCOMMITTEE OF THE BOARD OF DIRECTORS) A COPY IN ELECTRONIC OR PAPER FORM OF THE COMPLETED FORM 990 (AND ALL REQUIRED SCHEDULES) FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, BOARD DIRECTORS, AND KEY EMPLOYEES OF EVERY MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) ENTITY, AS WELL AS ANY OTHER PERSON DESIGNATED BY THE AUDIT AND COMPLIANCE COMMITTEE (ACC) TO BE A REQUIRED REPORTER BY VIRTUE OF HIS OR HER POSITION AT A SYSTEM ENTITY, SHALL ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. SUCH FORMS SHALL BE DISTRIBUTED AND RECORDED BY THE SYSTEM'S DESIGNATED COMPLIANCE OFFICER. ALL FINANCIAL INTERESTS DISCLOSED AS PART OF THE ANNUAL DISCLOSURE PROCESS SHALL BE REVIEWED BY THE ACC. THE ACC SHALL INFORM THE BOARD OF DISCLOSED FINANCIAL INTERESTS WHICH MAY BEAR UPON OR RELATE TO A TRANSACTION UPON WHICH THE BOARD OR ANOTHER BOARD, COMMITTEE OR OTHER BODY OF A SYSTEM ENTITY, MAY DELIBERATE OR ACT. IN ADDITION TO THE ANNUAL DISCLOSURES, IF AT ANY TIME BETWEEN ANNUAL DISCLOSURES, A REQUIRED REPORTER BECOMES AWARE THAT THE BOARD, OR A BOARD, COMMITTEE OR OTHER BODY, OF ANY SYSTEM ENTITY MAY DELIBERATE OR ACT UPON ANY TRANSACTION THAT MAY HAVE ANY BEARING OF ANY KIND UPON, OR MAY RELATE IN ANY MANNER TO, AN EXISTING, INTENDED OR EXPECTED FINANCIAL INTEREST OF THE REQUIRED REPORTER, HE OR SHE SHALL DISCLOSE THE FINANCIAL INTEREST TO THE RELEVANT SYSTEM ENTITY BOARD, COMMITTEE OR BODY CHAIR, AS WELL AS TO THE SYSTEM'S COMPLIANCE OFFICER, IN ADVANCE OF ANY DELIBERATIONS OR ACTION, WRITTEN DISCLOSURE OF THE EXISTENCE, NATURE AND EXTENT OF HIS OR HER FINANCIAL INTEREST. ALL WRITTEN OR ORAL DISCLOSURES OF FINANCIAL INTERESTS SHALL BE RECORDED IN THE MINUTES OF THE BOARD AND BY THE OFFICE OF THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER SHALL DISCLOSE THE COMPLETED FORMS AS NECESSARY TO THOSE MCHS EMPLOYEES RESPONSIBLE FOR COMPLETION OF THE IRS FORM 990. FORM 990, PART VI, SECTION B, LINE 15 THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE (COMPENSATION COMMITTEE) SHALL HAVE FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS (AS THAT TERM IS DEFINED IN 4958 OF THE INTERNAL REVENUE CODE (THE CODE)) EMPLOYED BY THE CORPORATION, INCLUDING BUT NOT LIMITED TO THE CORPORATION'S CEO. THE TERM DISQUALIFIED PERSONS INCLUDES (BUT IS NOT LIMITED TO) ANY PERSON (OR THE PERSON'S FAMILY MEMBER) WHO WAS, AT ANY TIME DURING THE 5-YEAR PERIOD ENDING ON THE DATE OF THE TRANSACTION, IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION. IT SHALL BE THE RESPONSIBILITY OF THE COMPENSATION COMMITTEE TO INSURE THAT THE SYSTEM DOES NOT PAY AN AMOUNT THAT EXCEEDS REASONABLE COMPENSATION FOR ANY DISQUALIFIED PERSON. THE COMPENSATION COMMITTEE AND ITS OPERATING PROCEDURES SHALL BE DESIGNED TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS OF COMPENSATION OUTLINED IN TREASURY REG. SEC. 53.4958-6 WITH RESPECT TO EACH DISQUALIFIED PERSON. IN DETERMINING REASONABLENESS OF COMPENSATION, THE COMPENSATION COMMITTEE SHALL EVALUATE APPROPRIATE INFORMATION AS TO THE COMPARABILITY OF COMPENSATION, INCLUDING BUT NOT LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE SYSTEM'S GEOGRAPHIC AREA; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; AND ACTUAL WRITTEN JOB OFFERS FROM SIMILAR INSTITUTIONS. THE COMPENSATION COMMITTEE SHALL HAVE INDEPENDENT AUTHORITY TO OBTAIN OUTSIDE EXPERT OPINIONS ON THE REASONABLENESS AND FAIR MARKET VALUE OF COMPENSATION AND GATHER OTHER INFORMATION IT CONSIDERS NECESSARY OR APPROPRIATE TO MAKE ITS DECISIONS ON COMPENSATION. THE COMPENSATION COMMITTEE SHALL TIMELY DOCUMENT ITS DETERMINATION OF REASONABLENESS OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE DOES NOT MAKE ITS CURRENT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UNLESS INCLUDED AS PART OF A FORM THAT IS REQUIRED TO BE PUBLICLY AVAILABLE. FORM 990, PART X, LINE 20: LAKEVIEW MEDICAL CENTER INC. IS PART OF THE MARSHFIELD CLINIC HEALTH SYSTEM OBLIGATED GROUP. SINCE THE OBLIGATED GROUP IS RESPONSIBLE FOR ALL OUTSTANDING FINANCED DEBT OBLIGATIONS, ALL BOND RELATED REPORTING IS DISCLOSED ON THE FORM 990 OF MARSHFIELD CLINIC HEALTH SYSTEM INC. FORM 990, PART XI, LINE 9: NET ASSET TRANSFERS WITH RELATED ORGS -8,386,168. 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